HER2+ Breast Cancer: Recent Data Updates and Key Advances

Heather McArthur, MD, and Debu Tripathy, MD, lead a discussion on risk stratification and optimizing treatment for HER2+ early breast cancer (eBC), followed by a review of standard-of-care systemic therapy regimens in the preoperative/neoadjuvant setting.

Panelists expand upon the most important clinical factors that inform selection amongst available systemic therapy regimens in the neoadjuvant setting of HER2+ eBC, comment on the potential for treatment de-escalation in lower-risk patients, and discuss exciting treatments on the horizon.

Dr Tripathy provides clinical insight on how he assesses HER2+ eBC patient response to neoadjuvant therapy, discusses the typical prognosis for those who do or do not have residual disease, and touches on how he might approach adjuvant treatment selection for each.

Virginia G. Kaklamani, MD, DSc, and Melinda L. Telli, MD, review the various adjuvant therapy options available for patients with HER2+ early breast cancer based on stage, risk status, and whether or not they had received neoadjuvant therapy, and then touch on clinical data supporting the use of fixed-dose pertuzumab/trastuzumab (PH) in this setting.

Drs Tripathy and McArthur touch on the use of extended adjuvant therapy with neratinib and identify patients who might be suitable for this regimen, including those high-risk patients with residual disease after neoadjuvant therapy.

Panelists discuss recent data updates on standard-of-care and emerging regimens for adjuvant treatment of HER2+ eBC, including data presented at the 2023 ASCO meeting, and highlight exciting trials in progress that have not yet read out.

Drs McArthur and Kaklamani expand upon the standard-of care regimens used for first-line treatment of patients with HER2+ metastatic breast cancer (mBC), review clinical data supporting their use, and share excitement for upcoming data readouts on novel regimens in the space.

Experts introduce the antibody-drug conjugates (ADCs) trastuzumab emtansine (T-DM1) and trastuzumab deruxtecan (T-DXd) and discuss clinical trial findings and potential use in special patient populations, such as those with brain metastases.

Panelists briefly touch on ongoing trials of second-line tucatinib combination therapy, including HER2CLIMB-02 and HER2CLIMB-05, in patients with or without brain metastases, and offer their clinical perspective which second-line regimens they typically recommend for their patients with HER2+ mBC.

Drs Tripathy and Kaklamani emphasize the most critical unmet needs for patients with HER2+ metastatic breast cancer in the third-line or higher settings and recap what the field previously learned from the HER2CLIMB trial of tucatinib/trastuzumab/capecitabine.

Drs McArthur and Telli discuss recent data updates from the DESTINY-Breast trials of T-DXd, including a pooled analysis, and share best practices for monitoring patients for lung complications.

Debu Tripathy, MD, discusses novel therapies being developed for later-line treatment of HER2+ mBC.

Experts share their go-to regimens in the third-line and higher setting of HER2+ metastatic breast cancer, and touch on the factors that support their decision-making.

Virginia G. Kaklamani, MD, DSc, presents a patient profile of early stage HER2+ breast cancer with residual nodal disease after neoadjuvant chemotherapy and surgery.

Melinda L. Telli, MD, presents a profile of a patient with early stage breast cancer with residual nodal disease after neoadjuvant chemotherapy and surgery, whose tumor was initially HER2+ but became triple-negative after treatment.

Dr Kaklamani presents a profile of a patient with HER2+ breast cancer and liver metastases who had disease progression after first-line chemotherapy and a solitary new brain metastasis after second-line T-DM1.

Panelists wrap up their discussion on HER2+ breast cancer by summarizing the most exciting recent advances in the field and their hopes for the future of treatment.